Department of Surgical and Perioperative Sciences, University of Umeå and Hospital of Östersund, Östersund, Sweden.
Department of Surgery, Hospital of Östersund, Östersund, Sweden.
Lancet. 2019 Mar 23;393(10177):1233-1239. doi: 10.1016/S0140-6736(18)32002-6. Epub 2019 Feb 21.
Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).
In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.
3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0·22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0·37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1·65 (95% CI 1·49-1·82; p<0·0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2·05 (1·92-2·19; p<0·0001). For the nulliparous women compared with men, the OR for anal incontinence was 1·89 (1·75-2·05; p<0·0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age.
The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed.
County Council of Jämtland.
在许多国家，择期剖宫产的数量迅速增加，其原因之一可能是人们普遍认为剖宫产可以预防盆底疾病，包括肛门失禁。此前关于这个问题的研究规模较小，结果存在冲突。本研究旨在比较经剖宫产分娩、经阴道分娩以及两个年龄匹配对照组（未产妇和男性）的女性中肛门失禁的发病风险。
在这项基于人群的观察性研究中，我们纳入了瑞典医疗出生登记处中所有在 1973 年至 2015 年期间经剖宫产或阴道分娩的女性，并在 2001 年至 2015 年期间根据瑞典国家患者登记处 ICD-8-10 诊断为肛门失禁。排除标准为多胎分娩、混合阴道和剖宫产分娩以及 4 次或更多次分娩。我们比较了仅经剖宫产分娩和仅经阴道分娩的女性之间的肛门失禁诊断情况。我们还将其与来自瑞典总人口登记处的两个年龄匹配的未产妇和男性对照组进行了比较。最后，我们分析了剖宫产和阴道分娩组中肛门失禁的危险因素。
研究共纳入了 3755110 名个体。1973 年至 2015 年间，185219 名女性仅行剖宫产，1400935 名女性仅行阴道分娩。在剖宫产组中，有 416 名（0.22%）女性被诊断为肛门失禁，而在阴道分娩组中，有 5171 名（0.37%）女性被诊断为肛门失禁。与剖宫产相比，阴道分娩后肛门失禁的比值比（OR）为 1.65（95%CI 1.49-1.82;p<0.0001）。与未产妇对照组相比，阴道分娩和剖宫产联合组诊断为肛门失禁的 OR 为 2.05（1.92-2.19;p<0.0001）。与男性相比，未产妇的肛门失禁 OR 为 1.89（1.75-2.05;p<0.0001）。阴道分娩后发生肛门失禁的最强危险因素是产妇年龄较大、胎儿出生体重较高和器械分娩。剖宫产后发生肛门失禁的唯一危险因素是产妇年龄。
妊娠和分娩后发生肛门失禁的风险增加。有已知肛门失禁危险因素的女性可能需要接受更专业的产后检查，以便在受伤时尽早进行干预。需要进一步了解以获得最佳管理方法。
耶姆特兰郡议会。
